| | Screening
for Risk-Drinking in Pregnancy
Principal
Investigator: Marcia Russell, Ph.D.
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TWEAK
is a five-item scale developed originally to screen for risk
drinking during pregnancy. It is an acronym for the questions
below (Russell, 1994):
| T |
Tolerance*--"How
many drinks can you hold?"
|
| W |
Worried--
"Have close friends or relatives Worried or Complained
about your drinking in the past year?"
|
| E |
Eye-openers--
"Do you sometimes take a drink in the morning when
you first get up?"
|
| A |
Amnesia
-- stands for blackouts-"Has a friend or family
member ever told you about things you said or did while
you were drinking that you could not remember?"
|
| K |
K/Cut
Down-- "Do you sometimes feel the need to K/Cut
Down on your drinking?" |
TWEAK
is one of the few alcohol screening tests that has been developed
and validated among women (Russell, Chan, & Mudar, 1997).
The utility of items included in the TWEAK was demonstrated
in studies of obstetric and gynecologic outpatients (Russell
& Bigler, 1979; Russell & Skinner, 1988; Sokol, Martier,
& Ager, 1989). It has been validated among disadvantaged
African-American women attending an inner-city prenatal care
clinic, using periconceptional risk drinking as a standard,
i.e., self-report of alcohol consumption averaging one or
more ounce of absolute alcohol per day, or 14 or more drinks
per week (Russell et al., 1994, 1996). Screening for periconceptional
risk drinking has the potential to improve pregnancy outcome
among risk drinkers by targeting them for intervention to
reduce their alcohol intake during pregnancy. Post-partum
follow-up to prevent resumption of harmful drinking patterns
will enhance women's ability to care for their newborns and
prevent alcohol-related fetal damage in subsequent pregnancies.
This research was extended to upper-middle class white patients
by Chang et al. (1999).
TWEAK
has also been used to screen for harmful drinking and a DSM-III-R
diagnosis of alcohol abuse or dependence in samples of the
general household population, outpatient samples, and hospital
inpatients (Chan et al., 1993) and in emergency room settings
(see el-Guebaly, Armstrong, & Hodgins, 1998 for a review).
It provides a quick and easy method of targeting outpatients
and in-patients in need of more thorough assessments of their
drinking patterns and alcohol-related problems to determine
whether treatment for alcoholism is needed. Information on
alcohol use may also be important in planning treatment for
patients' other health needs. Feedback on harm revealed by
the assessment has the potential to motivate patients to reduce
their alcohol intake, either on their own or by accepting
treatment (Miller, Sovereign, & Krege, 1988).
It
would be appropriate to conduct further work on the psychometric
properties of the instrument and its sensitivity and specificity
with respect to various alcohol outcomes (risk drinking during
pregnancy, harmful drinking, and alcohol abuse or dependence)
in a wide range of populations, particularly those seen in
community agencies with the capability to conduct follow-up
assessments of individuals who score positively on the TWEAK,
to conduct brief motivational counseling, and/or to refer
individuals judged appropriate for alcohol treatment (Institute
of Medicine, 1990). Eventually, the funding of research projects
with long-term follow-up to evaluate the costs and benefits
associated with such a program would be appropriate.
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Source Reference:
Russell,
M. (1994). New assessment tools for drinking in pregnancy:
T-ACE, TWEAK, and others. Alcohol Health and Research World,
18(1): 55-61.
Supporting
References:
Chan,
A. W. K., Pristach, E. A., Welte, J. W., & Russell, M.
(1993). Use of the TWEAK test in screening for alcoholism/heavy
drinking in three populations. Alcohol Clin Exp Res, 17(6),
1188-1192.
Chang, G.,
Wilkins-Haug, L., Berman, S., & Goetz, M. A. (1999). The
TWEAK: Application in a prenatal setting. Journal of Studies
on Alcohol, 60(3), 306-309.
El-Guebaly,
N., Armstrong, S. J., & Hodgins, D. C. (1998). Substance
abuse and the emergency room: Programmatic implications. Journal
of Addictive Diseases, 17(2), 21-40.
Institute
of Medicine. (1990). Broadening the Base of Treatment for
Alcohol Problems. Washington, DC: National Academy Press.
Miller, W.
R., Sovereign, R. G., & Krege, B. (1988). Motivational
interviewing with problem drinkers: II. The drinkers check-up
as a preventive intervention. Behavioural Psychotherapy, 16(4),
251-268.
Russell,
M., & Bigler, L. (1979). Screening for alcohol-related
problems in an outpatient obstetric-gynecologic clinic. Am
J Obstet Gynecol, 134, 4-12.
Russell,
M., Chan, A. W. K., & Mudar, P. (1997). Gender and screening
for alcohol-related problems, Gender and alcohol: Individual
and social perspectives. (pp. 417-444). In R. W. Wilsnack
& S. C. Wilsnack (Eds.). Piscataway, NJ, US: Rutgers Center
of Alcohol Studies.
Russell,
M., Martier, S. S., Sokol, R. J., Mudar, P., Bottoms, S.,
Jacobson, S., & Jacobson, J. (1994). Screening for pregnancy
risk drinking. Alcoholism: Clinical and Experimental Research,
18(5): 1156-1161.
Russell,
M., Martier, S. S., Sokol, R. J., Mudar, P., Jacobson, S.,
& Jacobson, J. (1996). Detecting risk drinking during
pregnancy: A comparison of four screening questionnaires.
Am J Public Health, 86(10), 1435-1439.
Russell,
M., & Skinner, J. B. (1988). Early measures of maternal
alcohol misuse as predictors of adverse pregnancy outcomes.
Alcohol Clin Exp Res, 12(6), 824-830.
Sokol, R.
J., Martier, S. S., & Ager, J. W. (1989). The T-ACE questions:
Practical prenatal detection of risk-drinking. Am J Obstet
Gynecol, 160(4), 863-870.
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